Customized Prosthetic Device Claims to Be Reprocessed

Since April 4, the Centers for Medicare & Medicaid
Services’ (CMS) claims processing system has been erroneously denying
claims for certain custom prosthetic devices. CMS is issuing instructions to
correct this processing error, but the correction will not be implemented until
Jan. 1, 2012.

In the interim, the Durable Medical Equipment Medicare
Administrative Contractors will reprocess any claims for custom prosthetic
devices (identified by the “L” series of Health Care Common Procedure
Coding System codes) that were inappropriately denied when such claims are
brought to their attention.

Part B payment can be made for items of prosthetics,
orthotics and supplies when they are furnished to a beneficiary who is in a
noncovered Part A stay at a hospital or skilled nursing facility (SNF). If
these items are furnished to beneficiaries residing in a covered Part A
hospital or SNF stay, under inpatient prospective payment system or SNF
consolidated billing payment rules, the items would be bundled into the global
Part A payment for the covered stay itself.

An exception to this policy is when certain customized
prosthetic devices are furnished to beneficiaries residing in a covered Part A
SNF stay because these items were carved out of the SNF consolidated billing
provision by the Balanced Budget Refinement Act of 1999.

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